Longitudinal multistate analysis: influence of gestational diabetes on the transition to prediabetes among NYC adolescents

Abstract

Nearly one-third of adolescent girls in the U.S. have prediabetes, with implications for the future rise of cardiovascular-related complications during pregnancy. Gestational diabetes is strongly associated with later life type 2 diabetes (T2DM) and cardiovascular risk, but its influence on the transition from normoglycemia to prediabetes is not well characterized. This study explores the influence of gestational diabetes on the transition to from normoglycemia to pre-diabetes in a population-based cohort of New York City (NYC) adolescents aged 10 to 19 years. We used data from the APPLE Cohort, a retrospective cohort of linked 2009-2017 birth certificate, hospital discharge, and NYC A1c Registry test data. Adolescents aged 10-19 with no history of type 2 diabetes comprised the baseline cohort among (n=39,874). We formulated a three-state multistate Markov model (normoglycemia (HbA1c< 5.7), pre-diabetes (5.7-6.4) and censored) for examining the influence of gestational diabetes (GDM) on the longitudinal transition from nomoglycemia to pre-diabetes. A total of 1.5% (N=602) pregnancies were complicated by GDM. In normoglycemia pregnancies uncomplicated by GDM, the probability of being in a pre-diabetes state at the next 12 month interval was 7% compared to 14% among those with GDM pregnancies. Similarly, the hazard ratio (HR) for the influence of GDM on the transition from normoglycemia to prediabetes was 1.9 (95% Confidence Interval: 1.3, 2.9). Adjusting for race/ethnicity, obesity and nativity, GDM pregnancies were still nearly 2 times more likely to transition to a prediabetes state (aHR 1.7, 95% CI: 1.2, 2.6) at an HbA1c test in the next 12 month interval compared to non-GDM pregnancies. While adolescents have a relatively low burden of T2DM, those who experience GDM are more likely to advance in disease progression sooner than their non-GDM counterparts. Results suggest the need for enhanced screening and monitoring of GDM adolescent patients following pregnancy to manage disease progression.